CGHS Order 2014 – Ceiling Rates for reimbursement of the cost of Cardiac pacemaker, AICD, Combo-device, Rotablator and Aortic Stent Graft to beneficiaries of CGHS/CS(MA) Rules

No: 12034/02/2014/Misc/-CGHS D.III
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
CGHS(P)

Nirman Bhawan, New Delhi
Dated the 22nd July, 2014.

OFFICE MEMORANDUM

Sub: Ceiling Rates for reimbursement of the cost of Cardiac pacemaker, AICD, Combo-device, Rotablator and Aortic Stent Graft to beneficiaries of CGHS/CS(MA) Rules.

With reference to the above mentioned subject the undersigned is directed to draw attention to the Office Memoranda No. S-11011/7/95-CGHS(P) dated 12/6/1996 and 26-164/98-R&H/CGHS/CGHS(P) dated 22/11/1999 vide which ceiling rates and guidelines were prescribed for various types of Pacemakers, Rotablator and AICD and to state that while the ceiling rates for coronary stents have been revised from time to time separately the rates and guidelines for pacemakers , Rotablator and AICD were not revised. The matter has been examined by the Ministry and it has been decided to revise the ceiling rates (incl. of all taxes) for these devices as per the details given below:

2. Permission for the above mentioned implants shall be granted on the basis of advice of Govt. cardiologist by CMO in-charge / Additional Director / Joint Director, CGHS in case of pensioners, former Governors, former Vice-Presidents, ex-MPs, Freedom Fighters, etc., by Rajya Sabha / Lok Sabha Secretariat as the case may be in case of sitting Members of Parliament and by the concerned Ministry / Department / Organization in case of serving Government employees, serving employees and pensioners of autonomous bodies covered under CGHS. The reimbursement shall be limited to the ceiling rate or actual rate, whichever may be less.

3. The Warranty terms and conditions as specified by the manufacturer shall be applicable in case of replacement of a device.

4. In case of requests for replacement of a device, a copy of the details of the earlier device as well as a copy of terms and conditions of Warranty shall be enclosed along with the advice of Govt. specialist.

5. A copy of the device ‘ID No Sticker‘ and a copy of terms of warranty shall be enclosed along with the bill of device for reimbursement.

6. In case of implantation of any of the devices in emergency, reimbursement shall be subject to ex-post facto approval by Addl. Director/Joint Director, CGHS of city, in consultation with experts, if necessary.

7. These orders are in supersession of earlier guidelines and ceiling rates issued in this regard.

8. The rates shall be valid for a period of two years or till further revision, whichever may be earlier.